PubMed · 2361682
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T A Wellington, W P Buick, H Benditsky. 1990. Patient satisfaction.. https://doi.org/10.1176/ps.41.6.681
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The CPPS uses staff respondents to portray practices and program climate of nonresidential mental health programs. We report psychometric analyses of 1,533 respondents in 165 programs. Confirmatory factor and partial credit analyses identified eight practice and five climate subscales, all of which show adequate psychometric properties. Program types are distinguished better by practices (R (2) values .37 to .52) than by climate (R (2) values .09 to .23), as expected. Multiple discriminant analysis and K-means cluster analysis illustrate how well the CPPS distinguishes program differences. The CPPS offers a promising, economical approach to measuring program practices in clinical trials comparing service programs.
Computer technology now allows clinical administrators to collect and analyze large data sets for performance monitoring. Despite the obvious usefulness of this technology, there are limitations. The indices that we can measure are at best proxies that might correlate with good clinical care but can also become dissociated from it in a variety of ways. First, there may not be a relationship throughout the entire continuum between the indicator and what we really value. Second, change in an indicator may not be associated with comparable change in the underlying value. Thirdly, the valence of an indicator can change depending on the context. Fourth, the very act of measuring an indicator can change its valence. Although, from a research perspective there may be technical solutions to these problems, in the real world where clinical care and politics meet, this may not be possible. Indices become reified. Measures become benchmarks and benchmarks quotas. Average is not a statistical phrase but a judgment and below average a term of approbation. To maximize the benefits of computerized monitoring, administrators need to be sensitive to this political dimension.
Despite growing interest in closing the "research to practice gap", there are few data on the availability of medications in American substance abuse treatment settings. Recent research suggests that organizational characteristics may be associated with medication availability. It is unclear if the availability of medications can be conceptualized in terms of "technology clusters", where the availability of a medication is positively associated with the likelihood that other medications are also offered. Using data from 403 privately funded and 363 publicly funded specialty substance abuse treatment centers in the US, this research models the availability of agonist medications, naltrexone, disulfiram, and SSRIs. Bivariate logistic regression models indicated considerable variation in adoption across publicly funded non-profit, government-owned, privately funded non-profit, and for-profit treatment centers. Some of these differences were attenuated by organizational characteristics, such as accreditation, the presence of staff physicians, and the availability of detoxification services. There was some evidence that naltrexone, disulfiram, and SSRIs represent a group of less intensely regulated medications that is distinct from more intensely regulated medications. These types of medications were associated with somewhat different correlates. Future research should continue to investigate the similarities and differences in the predictors of medication availability across national contexts.